ACUTE CHF: Rapid worsening of HF SX

Patho

• MC in pts with hx of underlying disease

  • HTN/HF med non-compliance, fluid overload/salt intake

  • Ischemia, arrhythmia, infxn, anemia, renal failure

  • Negative inotropes (verapamil, diltiazem), NSAIDs, cocaine/etOH

• Can occur in pts with no known hx

  • MI ➔ acute MR, thyroid storm, takotsubo, endocarditis, cardiac tamponade

SSX

• Perfusion (warm or cold)

  • Perfusing adequately ➔ warm

  • Hypoperfusion ➔ cold, shocky, AMS

    • Narrow pulse pressure,

• Think congestion (dry or wet)

  • Not congested ➔ dry

  • Congestion ➔ wet ➔ respiratory distress, flash pulmonary edema (frothy pink sputum), crackles on auscultation, edema (RHF)

DX

• ↑ BNP

• CXR can range from vascular redistribution to extensive alveolar edema

• Hypoxemia

• Get EKG and cardiac labs to ensure not ACS causing HF

TX - Respiratory support, diuretics, vasodilators

• AIRWAY/BREATHING

  • Maintaining airway (not so tired/altered they can't keep their head up)?

    • O2, 15lpm via NRB

  • Still low saturation or getting worse?

    • Non-invasive positive pressure ventilation (BiPAP/CPAP/BVM)

  • Still low saturation or getting worse?

    • Intubation

• WET

  • Make sure pt is not hypotensive then prompt diuresis via IV furosemide (↑ dose if already on ℞)

    • Monitor output, hypokalemia/natremia, alkalosis

  • Adjunctive vasodilator: NTG, ACEi, hydralazine (monitor for hypotension)

  • Call an adult to help with inotropes and pressors in hypotensive pts d/t reduced systolic function

• DRY

  • Typically d/t HTN or acute AR/MR ➔ vasodilator: nitroprusside (monitor for hypotension)